Manufacturer Invoice Correction Request form
for the
Coverage Gap Discount Program (CGDP)

This form was closed for use as of 09/05/2023 00:00:00.

It will be available for use again when the next quarter's reports are distributed.
Version 2.0, February 25th 2013

Manufacturer Invoice Correction Request form for the Coverage Gap Discount Program (CGDP)

Manufacturer Invoice Correction Request form
for the
Coverage Gap Discount Program (CGDP)